Wednesday, September 17, 2008

Last Thursday, as I drove up to Denver International Airport, I sensed something was wrong with my right eye. I wasn't sure what, but something was bothering me.

Friday morning, the "something wrong" continued. I got the sense that there was some kind of grayness in the lower right corner of my vision out of the right eye, but I couldn't be sure.

Saturday, my sense that something was wrong grew stronger. Saturday night, as we were heading to bed, I was standing in the semi-dark of our bedroom when Sarita turned off the lights in the hallway. Suddenly, it appeared to me, that the edge of my vision that had been dark was now glowing.

By Sunday evening, I had committed myself to call my optometrist to get the eye checked.

I finally got to see him yesterday at noon. As I described my symptoms, he said, "It sounds as if you have a detached retina, and I can't help you with that. You need to see an ophthalmologist as soon as possible."

As soon as I got home, I called Kaiser Permanente and asked for an appointment ASAP. They had to do some heavy schedule juggling, but they got me in yesterday afternoon.

After thorough testing, the doctor said, "Based on everything you told me, I was sure you had a detached retina. But your retina looks fine. However, I noticed your optic nerve is swollen. . . ." He then said something about neuropathy or neuritis, and then asked me a series of questions about experiences I may or may not have had. In every case, I said I had not had those particular experiences. . . .

To cut a longer story short, the doctor said he needed to do a bit of additional research on the computer, went out of the office and came back a few times, asking me a question or two at each reappearance, and finally offered his diagnosis: "non-arteritic anterior ischemic optic neuropathy" -- what I have since discovered is "affectionately" known as non-arteric AION or NAION . . . to distinguish it from AAION -- or arteritic AION: in layman's terms, the equivalent of a (relatively mild) heart attack or stroke to the optic nerve. The blood vessels feeding my optic nerve have been occluded, and so my optic nerve, starved for the nutrients it needs (including oxygen), has been damaged.

[Difference between arteritic and non-arteritic AIONs: the one variety involves arteries -- producing the equivalent of a major heart attack or stroke; the other involves smaller blood vessels and not the arteries, so the damage is less. Another major difference: arteritic AIONs destroy central vision; non-arteritic AIONs can produce the (relatively rare) loss only of peripheral vision. --Indeed, it was this matter that it was only my peripheral and not my central vision that caused my doctor his consternation and need to do additional research "on the spot." He has seen many patients who have lost central vision; I was the first he had seen who had lost "only" the bottom half of peripheral vision due to something other than a detached retina.]

"Can I get my sight back?" I asked.

"No," he said. "The portion of your optic nerve that has been affected has actually died. . . . And just as with a heart attack or a stroke, where the portion of the heart or brain affected actually dies and does not regenerate, so it is here. Your vision will not return."

He hesitated a moment and then said, "Well, let me not be quite so absolute. The literature offers no reason for hope. But who am I to say it could never happen? . . ."

He turned to my medical chart and began asking me questions about my general health. In a longer conversation, when we got to the subject of cholesterol and I told them about Dr. Leonardi's discoveries, his face lit up (as much as a doctor is willing to let his face light up at a patient's misfortune): "Your cholesterol got you."

And so, though I didn't have a heart attack (praise God!), my elevated cholesterol levels -- or, more particularly, the large number of cholesterol molecules and their small size -- have caught up with me.

"The things we have all been hearing about for the last 20 years, the need for a healthy diet, exercise, no smoking, etc.: you need to pay attention to that," said the doctor.

He urged me to take an aspirin a day to keep my blood thin and, hopefully, avoid further damage.

Last Thursday, as I drove up to Denver International Airport, I sensed something was wrong with my right eye. I wasn't sure what, but something was bothering me.

Friday morning, the "something wrong" continued. I got the sense that there was some kind of grayness in the lower right corner of my vision out of the right eye, but I couldn't be sure.

Saturday, my sense that something was wrong grew stronger. Saturday night, as we were heading to bed, I was standing in the semi-dark of our bedroom when Sarita turned off the lights in the hallway. Suddenly, it appeared to me, that the edge of my vision that had been dark was now glowing.

By Sunday evening, I had committed myself to call my optometrist to get the eye checked.

I finally got to see him yesterday at noon. As I described my symptoms, he said, "It sounds as if you have a detached retina, and I can't help you with that. You need to see an ophthalmologist as soon as possible."

As soon as I got home, I called Kaiser Permanente and asked for an appointment ASAP. They had to do some heavy schedule juggling, but they got me in yesterday afternoon.

After thorough testing, the doctor said, "Based on everything you told me, I was sure you had a detached retina. But your retina looks fine. However, I noticed your optic nerve is swollen. . . ." He then said something about neuropathy or neuritis, and then asked me a series of questions about experiences I may or may not have had. In every case, I said I had not had those particular experiences. . . .

To cut a longer story short, the doctor said he needed to do a bit of additional research on the computer, went out of the office and came back a few times, asking me a question or two at each reappearance, and finally offered his diagnosis: "non-arteritic anterior ischemic optic neuropathy" -- what I have since discovered is "affectionately" known as non-arteric AION or NAION . . . to distinguish it from AAION -- or arteritic AION: in layman's terms, the equivalent of a (relatively mild) heart attack or stroke to the optic nerve. The blood vessels feeding my optic nerve have been occluded, and so my optic nerve, starved for the nutrients it needs (including oxygen), has been damaged.

[Difference between arteritic and non-arteritic AIONs: the one variety involves arteries -- producing the equivalent of a major heart attack or stroke; the other involves smaller blood vessels and not the arteries, so the damage is less. Another major difference: arteritic AIONs destroy central vision; non-arteritic AIONs can produce the (relatively rare) loss only of peripheral vision. --Indeed, it was this matter that it was only my peripheral and not my central vision that caused my doctor his consternation and need to do additional research "on the spot." He has seen many patients who have lost central vision; I was the first he had seen who had lost "only" the bottom half of peripheral vision due to something other than a detached retina.]

"Can I get my sight back?" I asked.

"No," he said. "The portion of your optic nerve that has been affected has actually died. . . . And just as with a heart attack or a stroke, where the portion of the heart or brain affected actually dies and does not regenerate, so it is here. Your vision will not return."

He hesitated a moment and then said, "Well, let me not be quite so absolute. The literature offers no reason for hope. But who am I to say it could never happen? . . ."

He turned to my medical chart and began asking me questions about my general health. In a longer conversation, when we got to the subject of cholesterol and I told them about Dr. Leonardi's discoveries, his face lit up (as much as a doctor is willing to let his face light up at a patient's misfortune): "Your cholesterol got you."

And so, though I didn't have a heart attack (praise God!), my elevated cholesterol levels -- or, more particularly, the large number of cholesterol molecules and their small size -- have caught up with me.

"The things we have all been hearing about for the last 20 years, the need for a healthy diet, exercise, no smoking, etc.: you need to pay attention to that," said the doctor.

He urged me to take an aspirin a day to keep my blood thin and, hopefully, avoid further damage.